الفهرس 
Prevalence of NAFLD in High-Risk GroupsOnly 14 pages are availabe for public view
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Abstract
Background: Nonalcoholic fatty liver disease (NAFLD) is the most common cause of chronic liver disease in the worldwide occurring in 33 % of the general population and in over 90% of the patients with morbid obesity that are undergoing bariatric surgery. NAFLD encompasses a histological spectrum ranging from simple steatosis (NAFLD) to nonalcoholic steatohepatitis (NASH) with various degrees of fibrosis that may progress eventually to cirrhosis. A key issue for the prognosis and management of NAFLD is the differentiation of simple steatosis from NASH. To date, liver biopsy remains the best gold standard for diagnosing NASH and grading the severity of liver damages but it is invasive procedure. There is an urgent need for a less invasive method than biopsy of screening the population, stratifying disease severity and following disease progression.
Aim of the Work: To evaluate promising non-invasive predictive biomarkers used to distinguish between NASH and simple steatosis in morbidly obese patients undergoing bariatric surgery.
Patients and Methods: This was a case control study conducted in morbidly obese patients before they had gone bariatric surgery between January 2018 and January 2020 with a total number of 30 patients.
We included morbidly obese patients (BMI≥40 kg/m²) undergoing bariatric surgeries. Liver biopsies were obtained at time of bariatric surgery and examined by single pathologist and graded according to NAFLD activity score (NAS),
Results: This study was conducted on 30 patients who were morbidly obese before they had gone bariatric surgery at Ain Shams University Hospitals. Among the 30 patients, 21 of them diagnosed as NASH by the liver biopsy, 42.9% of the NASH patients were diabetic, and 47.6% of them were hypertensive. The BMI and hip circumference were highly significant with NASH with cut off level of BMI >42.6 and 85.71% sensitivity and 66.67% specificity. Using AUC analysis, we established for these parameters the following cutoff levels being indicative of NASH with the highest accuracy (equal or above): BMI of 42.6 kg/m2, HOMA-IR of >3.6. For adiponectin, a value equal or below 2.9 mg/L was indicative of NASH and hs-CRP of above 1.5 mg/L.
Conclusion: BMI> 42.6 kg/m², HOMA-IR, adiponectin, hs-CRP are good non- invasive indicators for NASH in morbidly obese patients undergoing bariatric surgeries.